Why do doctors practice defensive medicine?

According to a survey reported by the JAMA Network, 93% of doctors reported practicing defensive medicine. Defensive medicine happens when doctors order tests or medical treatments that are not necessarily in the best interest of their patients. They do this not for the health of their patients but to protect themselves from the possibility of legal actions in the future. It adds costs to our system of healthcare.

Everyone probably has experienced defensive medicine, where an HCP orders more tests for minor health problems. Doctors do this to protect themselves against litigation for wrong or missed diagnostic findings.

There are two forms of defensive medicine, assurance behaviors and avoidance behaviors. Assurance behaviors, or “positive” defensive medicine, involve providing additional services to ensure that legal standards of care are met to avoid malpractice claims. Avoidance behavior, or “negative” defensive medicine, refers to physicians’ efforts to avoid high-risk patients and procedures.

Experts believe defensive medicine is a significant reason for rising healthcare costs in the United States. According to a study published in Health Affairs in 2018, defensive medicine is estimated to add $25.6 billion to healthcare costs yearly, comprising as much as 34% of all healthcare costs in the United States. In addition to financial costs, the National Institutes of Health says that defensive medicine has negative consequences for patients, doctors, and the patient-doctor relationship.

Does Defensive Medicine ‘Work’?

Higher-spending physicians face fewer malpractice claims, a study led by researchers at Harvard Medical School has found. Nearly three-quarters of physicians report practicing defensive medicine, broadly defined as ordering tests, procedures, physician consultations, and other medical services to reduce the risk of malpractice claims. Defensive medicine costs the U.S. as much as $50 billion annually.

 Research led by Anupam Jena, associate professor of health care policy at Harvard Medical School and an internist at Massachusetts General Hospital, found overall, 4,342 malpractice claims were filed against physicians (2.8 percent per physician-year), with malpractice claims rates ranging from 1.6 percent per physician-year in pediatrics to 4.1 percent per physician-year in general surgery and obstetrics and gynecology.

Among internal medicine physicians, those in the bottom 20 percent of hospital spending (approximately $19,000 per hospitalization) faced a 1.5 percent probability of being involved in an alleged malpractice incident the following year, compared to 0.3 percent in the top spending quintile (approximately $39,000 per hospital admission).

“The threat of malpractice is a very salient risk for most practicing physicians, particularly in high-risk specialties,” Seabury said. “If physicians perceive that higher spending can protect them from malpractice claims, then they are likely to practice defensively even if they feel that the additional spending is unnecessary or offers no clinical benefits to patients.”

Defensive medicine is one reason so many insurers require prior authorization. They want to remove unnecessary tests, but rather than look out for the patient’s best interest, prior authorizations have become a way to increase profits.

One insurer, however, is taking action. UnitedHealthcare said it would remove many procedures and medical devices from its list of services requiring prior authorization. Starting in the third quarter, it will remove many functions and medical devices from its list of services requiring signoff. There is, however, a long way to go.

 Cigna, one of the country’s largest insurers, has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials.

Over two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. The company has reported it covers or administers health care plans for 18 million people.

One solution is for all health insurers to be “non-profit,” but that won’t happen. There must be definitive clinical guidelines for additional medical tests and exceptions based on a patient’s medical history and family history of medical problems.

Patients don’t like to wait for more medical tests, and they hate the bills that show up after tests requiring more money.

 Medical Group Management Association survey revealed that most doctors have seen their malpractice premiums increase since 2020, and some of those increases have been dramatic. The majority (62%) said their rates had increased, 5% said they decreased, and 33% said they stayed the same.

Many Americans cannot afford adequate medical care. Physicians and other healthcare providers have long argued that malpractice claims cause escalating healthcare costs. The worry is that as legal malpractice suits become more commonplace and claimants receive settlements for millions of dollars, patients will have to swallow some of these costs through higher insurance premiums and doctor’s fees. The US Bureau of Justice Statistics data shows that 50% of all medical malpractice cases are filed against surgeons with paid claims on medical errors totaling 20 billion dollars in the USA in 2021. This is a crucial reason doctors practice defensive medicine.

It’s all a symptom of a healthcare system that’s very broken.